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Crossing the line: What to do when community crime leaks onto the hospital campus


Over the past several years, Minneapolis has seen an uptick in violent crime rates, and in some cases, hospitals are feeling the brunt of it.

Crossing the line: What to do when community crime leaks onto the hospital campus

A Minneapolis hospital has been forced into four lockdowns since April

Over the past several years, Minneapolis has seen an uptick in violent crime rates, and in some cases, hospitals are feeling the brunt of it.

In April, the Minneapolis Police Department (MPD) issued a report that showed an 8% increase in gun incidents from 2012 to 2013. According to MPD statistics through the month of September, total violent crimes citywide were up nearly 4% from 2013 with more than 3,000 total incidents.

Although violent crime throughout the nation is generally trending downward, pockets of violent crime still exist. According to data from the FBI, violent crime decreased 3.6% in metropolitan counties within the first six months of 2013. The largest regional decrease was in the Midwest (7.4%). Anecdotally, however, those statistics haven't been reflected in Minneapolis.

Hennepin County Medical Center (HCMC), which is located in the heart of Minneapolis, has seen crime spill onto its campus at an alarming rate over the past six months. Since April, HCMC has gone into lockdown four times, three of which were gun-related.

The most recent lockdown, on September 21, was initiated after someone noticed a man with a weapon outside of the hospital. Previously, on August 26, a shooter left 23 bullet casings in an intersection 100 feet from the ED entrance. Bullets shattered hospital windows and doors and "sent panicked staff and patients ducking for cover," according to the Star Tribune.

"We live in a dynamic environment and a dynamic community, and I think as a level one trauma center…we are going to see that same kind of activity show up at our doors," Scott Wordelman, the hospital's vice president of ambulatory administration, told WCCO CBS Minnesota.

According to another local news station, KARE 11, the hospital is upgrading its surveillance cameras, training staff, and installing a new communications alert system in response to recent events. HCMC declined to comment for this story.

The issues that HCMC has faced highlight some of the important security concerns that arise when community crime spills over into the hospital environment, says Dick Sem, CPP, CSC, president and security consultant for Sem Security Management in Lake Geneva, Wisconsin.

"I think it's more a reflection of the community or their neighborhood than perhaps the hospital itself," he says. "It sounds like they are in a pretty high crime area. There's been escalation of street crime around Minneapolis, and in some other major cities like Chicago. I think this is a reflection of that."

From what he's read, Sem believes HCMC is doing the right things to try and mitigate this violence by improving security systems and reinforcing its relationship with local police. Many of these events, like the August 26 shooting, were virtually unpreventable.

"You're never perfect," he adds. "You're never 100%, so every time you have an incident, it behooves you to sit down and say, 'What can we do better?' "


Mitigating community crime

The potential violence associated with increased community crime underscores the importance of developing a close working relationship with local law enforcement, Sem says. Medical centers that are able to establish this relationship typically receive valuable information from the department's gang unit.

"That can be a useful source of information for the hospital to be more aware of their environment, their community, and where the risks are on the outside," he says.

In particular, Sem recounts working with two hospitals in Los Angeles and Denver where hospital and security administrators actually arranged a meeting with local gang leaders through the police department. The hospital explained to the gang leaders that one day their mothers, sisters, daughters, and family members would need to use the hospital, so bringing violence onto the hospital campus was disruptive to a valuable community resource.

"That actually worked in some situations where the gang leaders got the word out that the hospital is sacred ground and you don't mess with the hospital," Sem says.

In the hospitals that he has worked with following a shooting, Sem says administrators often want to install metal detectors in the entryways, but that isn't always the appropriate solution. In many cases, metal detectors present an appearance of security, but do little to actually mitigate the risk of violence. In some high crime areas, however, he admits that the hospital may be forced to go in that direction. If it does, the hospital will also need very specific protocols behind the operation of such equipment.

Community violence can have particular implications for the ED, says Tom Aumack, CHPA, HSS security program manager serving Cheyenne Regional Medical Center (CRMC) in Wyoming. Aumack notes that even though Cheyenne has a relatively low crime rate, CRMC has been forced into a lockdown due to community shooting events. Security should be aware of the circumstances of any gunshot victim that comes to the hospital to determine if the event might be gang-related.

"I know that when we have a gunshot wound come into the emergency room, we're pretty anxious to get some preliminary indication on what the incident was that generated it," he says.


Improving staff training

As hospitals contend with active shooters?either in their community or in their facility?Aumack says frontline staff members need to be appropriately trained and prepared to handle a potential active shooter scenario. He utilizes a free, 11-minute video titled Armed! Are You Ready? to train staff members. The video was developed by the Emergency Preparedness Bureau at the Massachusetts Department of Health and is publically available at ­http://­activeshootertraining.net.

One of the important issues the video addresses is the idea that healthcare workers may not be able to save all their patients during an active shooter scenario, or at least may be faced with a difficult life or death situation. The video helps staff members recognize the real implications of an active shooter situation and prepare themselves for that possibility.

"At a minimum, they know that if it comes to that last resort where serious injury or death might exist, you might be forced to make that decision," Aumack says. "And the way you prepare to make that decision is certainly the way I think you're generally going to act."

Aumack says CRMC has rolled the video out to department leaders to show during their department meetings. Additionally, frontline staff members are provided basic training during their new employee orientation.

"We want to get the message out to the people in the trenches that are actually the people that will be initially confronted with these types of situations," he says.


FBI unveils active shooter statistics

Although active shooter incidents have been steadily increasing since 2000, new data from the FBI reveals that active shooters in healthcare facilities make up a small percentage of events around the country.

A new report released by the FBI in September studied 160 active shooter incidents between 2000 and 2013. In those identified incidents, 486 people were killed and 557 were wounded. Additionally, the FBI determined that active shooter events have been steadily increasing since 2000, averaging 6.4 incidents annually for the first seven years of the study and increasing to 16.4 annually in the last seven years.

In the FBI's release, Special Agent Katherine Schweit, who heads the Active Shooter Initiative, said she hopes the study "demonstrates the need not only for enhanced preparation on the part of law enforcement and other first responders, but also for civilians to be engaged in discussions and training on decisions they'd have to make in an active shooter situation."

Only four of the 160 identified events in the FBI's report took place in a healthcare institution. In those four incidents, 10 people were killed and 10 were wounded. However, the report notes that the FBI applied a "limited scope" when selecting active shooter events, electing to exclude events resulting from gang or drug violence as well as gun-related incidents that "appeared generally not to have put others in peril."

This nuanced definition likely removes from consideration many of the active shooter or gun-related incidents that take place in healthcare facilities each year, says Tom Aumack, CHPA, HSS security program manager serving Cheyenne Regional Medical Center (CRMC) in Wyoming. Aumack has been using news reports to track weapons discharges in hospitals nationwide (see the April issue of Healthcare Security Alert). At presstime, he had tracked 37 incidents in 2014, which is on pace to surpass last year's total of 38.

A December 2012 study published in the Annals of Emergency Medicine identified 154 hospital-related shootings between 2000 and 2011. The authors concluded that hospital shootings were "relatively rare compared with other forms of workplace violence."

Aumack adds that the vast majority of weapons discharge incidents in healthcare result in only one or two causalities, often involving suicide, which likely excluded them from the FBI's report. Frequently, these incidents are also targeted, as opposed to other major active shooter incidents highlighted in the FBI report (Aurora, Sandy Hook, and Virginia Tech), in which the shooter selected victims at random. Aumack cites the 2010 Johns Hopkins shooting in which the perpetrator was specifically targeting the doctor because he wasn't satisfied with the care his mother was receiving.

"A lot of times you get that older shooter in healthcare where their lifelong partner is very, very sick and they just can't take it anymore, so they go in there to put their loved one out of their misery, and then they end up turning the weapon on themselves," Aumack says.

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